Surgical retractor having lifting capability

ABSTRACT

A surgical retractor includes a pair of small grips that are disposed at the ends of arms that can be moved toward or away from each other. The grips engage and separate the sides of an incision that has been made in a patient. A lifting mechanism that can be attached to one of the arms enables one side of the incision to be raised relative to the other side of the incision. The lifting mechanism includes a clamp that can be connected to the retractor and a foot that is connected to the clamp and which is movable relative thereto. The foot is engageable with the patient such that extension of the foot causes a selected grip to be raised. Retraction of the foot permits the selected grip to be lowered. In the preferred embodiment, the foot is disposed at one end of a notched rack; a rotatable pinion is in contact with the notches to extend and contract the rack; and a pivotally movable pawl permits movement of the rack in one direction and prevents movement of the rack in the other direction.

REFERENCE TO RELATED APPLICATION

The present application is a continuation of application Ser. No.11/162,250, filed Sep. 2, 2005 by Albert N. Santilli, entitled SurgicalRetractor Having Lifting Capability, which is now U.S. Pat. No.7,270,632, which claimed priority from provisional application Ser. No.60/607,474, filed Sep. 3, 2004 by Albert N. Santilli, entitled SurgicalRetractor Having Lifting Capability. The present application claimsbenefit of the referenced applications and incorporates both of themherein by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention relates to retractors that are used in various types ofsurgeries such as cardiovascular surgery and, more particularly, to aretractor that permits such operations to be conducted with minimaltrauma to the patient.

2. Description of the Prior Art

In the course of such operative procedures as mitral valve surgery andmammary artery surgery, it is necessary to expose the heart. Suchexposure traditionally has been accomplished by performing a fullsternotomy (cutting an incision completely through the sternum andretracting the sternum). The retraction is accomplished by a retractorthat employs parallel grips that engage the edges of the separatedsternum. The grips are mounted perpendicularly to a toothed crossbar.One of the grips is fixed to one end of the crossbar, while the othergrip is movably mounted to the crossbar by means of a pinion thatengages the teeth of the crossbar. Upon rotating the pinion, the movablegrip can be moved away from the fixed grip, thereby retracting thesternum so as to expose the heart. A retractor of the type described isshown in U.S. Re. 34,150, issued Dec. 29, 1992 to A. E. Santilli and D.M. Cosgrove III (“the '150 patent”), the disclosure of which isincorporated herein by reference.

A surgical retractor that is less invasive than that disclosed in the'150 patent is disclosed in U.S. Pat. No. 6,099,468, issued Aug. 8, 2000to A. N. Santilli and A. Patel (“the '468 patent”), the disclosure ofwhich is incorporated herein by reference. The retractor according tothe '468 patent includes a pair of very small parallel grips that aremounted to a toothed crossbar. As in the device disclosed in the '150patent, the grips are disposed at the ends of arms that extend at rightangles from the crossbar. One of the arms is fixed to one end of thecrossbar, while the other arm is movable along the crossbar by means ofa pinion so that the grips can be moved toward or away from each other.

The retractor according to the '468 patent is smaller than priorretractors, and therefore less invasive. By using the retractoraccording to the '468 patent, a partial sternotomy, rather than a fullsternotomy, can be performed in order to have access to the heart. Whilethe retractor according to the '468 patent is less invasive, it canretract the sternum or ribs only in one plane. That is, the sternum orribs are pulled straight apart. There are a variety of circumstances inwhich it is desirable not only to retract the sternum or ribs, but alsoto lift one side of the incision relative to the other.

A surgical retractor that permits one side of the incision to be liftedrelative to the other side is disclosed in U.S. Pat. No. 6,361,492,issued Mar. 26, 2002 to Albert N. Santilli (“the '492 patent”), thedisclosure of which is incorporated herein by reference. As in thedevice disclosed in the '468 patent, the retractor disclosed in the '492patent includes relatively small grips or paddles that are insertedthrough a small opening formed between adjacent ribs or a portion of thesternum. The retractor in question includes a two-part toothed crossbarthat has a pivoted connection at or near its center. The retractor has acrank mechanism connected between the opposed arms that permits the armsto be pulled toward or away from each other in order to pivot thecrossbar about the pivot. Such pivoting of the crossbar enables one armto be lifted relative to the other. In turn, one side of the incisioncan be lifted relative to the other side.

While the device according to the '492 patent is effective to lift oneside of the incision, there are many situations in which there is noneed, or it is undesired, for the retractor to have pivoting portions.It would be desirable to be able to lift one side of the incisionrelative to the other without the complexity, expense, or bulkiness of apivot and accompanying crank mechanism. Any such retractor preferablywould permit minimally invasive surgical procedures to be performed.

SUMMARY OF THE INVENTION

In response to the foregoing concerns, the present invention provides anew and improved surgical retractor and lift mechanism therefor. In thepreferred embodiment, the retractor according to the invention includesa pair of small grips that are disposed at the ends of arms that arejoined by a crossbar. One of the arms is fixed to the crossbar and theother arm can be moved toward or away from the other arm. The arms andthe crossbar each include at least one generally flat portion. The gripsengage and separate the sides of an incision that has been made in apatient. A lifting mechanism that can be attached to one of the arms orthe crossbar enables one side of the incision to be raised relative tothe other side of the incision.

The lifting mechanism includes a clamp that can be connected to theretractor and a locking mechanism that selectively locks the clamp tothe retractor. The lifting mechanism includes a foot that is connectedto the clamp and which is movable relative thereto. The foot isengageable with the patient such that extension of the foot causes theretractor to be raised and contraction of the foot causes the retractorto be lowered.

In the preferred embodiment, the lifting mechanism includes a posthaving first and second ends and a longitudinal axis, the first endbeing connected to and extending from the clamp. A formation isconnected to the second end of the post, the formation having an openingtherethrough, the opening having an axis that is spaced from andgenerally parallel with the longitudinal axis of the post. A rack havingfirst and second ends and notches along one side is disposed within theopening for movement back and forth therein. The foot is connected tothe first end of the rack. A rotatable pinion is carried by theformation, the pinion being in contact with the notches. A wingnut isconnected to the pinion, the wingnut being accessible to a user. A pawlhaving first and second ends is connected to the formation, the firstend being biased into contact with the notches and the second end beingaccessible to a user. The pawl is pivotally mounted to the formationsuch that the first end permits movement of the rack in one directionand prevents movement of the rack in the other direction.

The lifting mechanism according to the invention is quite compact. Itcan be attached to the retractor quickly and easily and can besterilized for indefinite reuse. The foot is designed to press againstthe patient with relatively low pressure. The interaction of the notchesand pawl enables the retractor and, hence, one side of the incision, tobe raised in small, carefully controlled increments. When the surgicalprocedure has been completed and it is desired to remove the retractor,the raised side of the incision can be lowered readily merely byreleasing the pawl.

The foregoing and other features and advantages of the invention will beapparent from a review of the following description of the invention,together with the attached drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a lifting mechanism according to theinvention disposed in position to be attached to a surgical retractor;

FIG. 2 is a rear view of the lifting mechanism of FIG. 1; and

FIG. 3 is a side elevation view of the lifting mechanism of FIG. 1.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring generally to FIGS. 1-3, a surgical retractor according to theinvention is indicated generally by the reference numeral 10. Theretractor 10 is of the Finochietto type. The retractor 10 includes apair of small, generally rectangular parallel grips 12, 14. The grips12, 14 have rectangular openings 16, 18 formed therein, respectively.The grips 12, 14 are mounted at the ends of arms 20, 22, respectively.

The arms 20, 22 extend at right angles away from a crossbar 24 having aplurality of spaced teeth 26. The arm 20 is fixed to the crossbar 24,while the arm 22 is movable along the crossbar 24 so as to move the grip14 toward or away from the grip 12. Movement of the arm 22 isaccomplished by a pinion 28 that engages the teeth 26 of the crossbar24. A handle 30 is connected to the pinion 28 for purposes of rotatingthe pinion 28. The arms 20, 22 and the crossbar 24 each define one ormore generally flat portions.

Retractor blades and/or stabilizers (not shown) can be attached to thearms 20, 22 in order to retract or stabilize portions of the patient'sanatomy. Reference is made to the '150 patent, the '468 patent, and the'492 patent for teachings of representative retractor blades andstabilizers that can be attached to the arms 20, 22.

A lifting mechanism according to the invention is indicated generally bythe reference numeral 40. The lifting mechanism 40 includes a lockingmechanism in the form of a C-shaped clamp 42 that can be connected tothe retractor 10 by being fitted about a selected generally flat portionof one of the arms 20, 22 or the crossbar 24. The clamp 42 includes apair of spaced-apart members that are generally parallel with eachother, the spaced-apart members defining a space therebetween into whicha selected generally flat portion can be disposed. The spaced-apartmembers are joined by a connection along one edge thereof. In theillustrated embodiment, the clamp 42 is connected to the fixed arm 20.The clamp 42 has a threaded opening (not shown) through which a threadedpin 44 extends for engagement with the arm 20.

The lifting mechanism 40 includes a post 46 having first and second ends48, 50 and a longitudinal axis 52. The first end 48 is connected to andextends from the clamp 42. A formation 54 is connected to the second end50. The formation 54 has a non-round, preferably square, opening 56therethrough. The opening 56 has an axis 58 that is spaced from andgenerally parallel with the longitudinal axis 52 of the post 46.

A rack 60 having first and second ends 62, 64 and notches 66 along oneside is disposed within the opening 56 for movement back and forththerein. The cross-section of the rack 60 is of a size and shape to fitsnugly in the opening 56. A foot 68 is connected to the first end 62 ofthe rack 60. The foot 68 is illustrated as being generally rectangular,although it can be of any shape, such as circular, that will exertrelatively low pressure on the patient during use. A rotatable pinion(not shown) is carried by the formation 54. The pinion is in contactwith the notches 66. A wingnut 70 is connected to the pinion. Thewingnut 70 is accessible to the surgeon so that the pinion can be turnedreadily.

A pawl 72 having first and second ends 74, 76 is pivotally connected tothe formation 54. The first end 74 is biased into contact with thenotches 66 by means of a spring (not shown) disposed between the secondend 76 and the formation 54. The second end is accessible to thesurgeon. The pawl 72 is mounted to the formation 54 such that the firstend 74 permits movement of the rack 60 in one direction (extension ofthe foot 68) and prevents movement of the rack 60 in the other direction(contraction of the foot 68) unless the second end 76 has been pressed.

It is expected that the retractor 10 will be used as follows. Initially,the handle 30 will be rotated so that the arm 22 will be moved towardthe arm 20. Accordingly, the grips 12, 14 will be immediately adjacenteach other. Due to the small size and shape of the grips 12, 14, thethoracic cavity need be opened only a small amount, for example, adistance of about 4 inches. After inserting the grips 12, 14 into theincision, the sternum can be retracted by turning the handle 30 to movethe grip 14 away from the grip 12.

Either before or after the grips 12, 14 have been moved apart, the clamp42 is attached to the arm 20 or the arm 22 or the crossbar 24 andretained there by the threaded pin 44. Thereafter, the wingnut 70 isturned so that the pinion moves the rack 60 in a direction to extend thefoot 68. Eventually, the foot 68 will contact the patient. Continuedrotation of the wingnut 70 will cause the retractor 10 to be lifted. Asa consequence, one side of the incision will be lifted relative to theother side. The wingnut 70 can be rotated in small, carefully controlledincrements determined by the spacing of the notches 66. After thedesired amount of lifting has been attained, the position of the rack 60will be maintained by the pawl 72.

After the surgical procedure has been completed, the surgeon can presson the second end 76 of the pawl 72. The first end 74 will be disengagedfrom the notches 66, thereby permitting the rack 60 to be moved to acontracted position. Thereafter, the retractor 10 can be removed fromthe patient by reversing the previously described steps.

Although the invention has been described in its preferred form with acertain degree of particularity, it will be understood that the presentdisclosure of the preferred embodiment has been made only by way ofexample and that various changes may be resorted to without departingfrom the true spirit and scope of the invention as hereinafter claimed.It is intended that the patent shall cover, by suitable expression inthe appended claims, whatever features of patentable novelty exist inthe invention disclosed.

What is claimed is:
 1. A lifting mechanism for use with a surgicalretractor in a surgical procedure on a patient, the retractor having oneor more generally flat portions, comprising: a clamp that can beconnected to the retractor, the clamp being of a size and shape to bedisposed about any selected generally flat portion of the retractor; alocking mechanism to selectively lock the clamp to the selectedgenerally flat portion of the retractor; a foot connected to the clamp,the foot being movable relative to the clamp while the clamp isconnected to the retractor, the foot being engageable with the patientsuch that extension of the foot causes the retractor to be raised andcontraction of the foot causes the retractor to be lowered, whereby theretractor moves along a path; a post having first and second ends and alongitudinal axis, the first end connected to and extending from theclamp, the longitudinal axis extending generally parallel with the paththe retractor moves along when it is raised and lowered; a formationconnected to the second end of the post, the formation having an openingtherethrough, the opening having an axis that is spaced from andgenerally parallel with the longitudinal axis of the post; a rack havingfirst and second ends and notches along one side, the rack beingdisposed within the opening for movement back and forth therein, thefoot being connected to the first end of the rack; a rotatable pinioncarried by the formation, the pinion being in contact with the notches;a wingnut connected to the pinion, the wingnut being accessible to auser; and a pawl having first and second ends connected to theformation, the first end being spring-biased toward contact with thenotches and the second end being accessible to a user, the pawl beingpivotally mounted to the formation such that the first end permitsmovement of the rack in one direction and prevents movement of the rackin the other direction.
 2. The lifting mechanism of claim 1, wherein theopening in the formation is non-round in cross-section and the rack isof a size and shape to fit snugly within the opening.
 3. A liftingmechanism for use with a surgical retractor in a surgical procedure, theretractor having first and second arms connected by a crossbar, thefirst arm being fixed to the crossbar and the second arm being movablealong the crossbar toward and way from the first arm, the first andsecond arms and the crossbar having one or more generally flat portionsand each of the first and second arms having grips that engage andseparate the sides of an incision that has been made in a patient, thelifting mechanism permitting one side of the incision to be raisedrelative to the other side of the incision, the lifting mechanismcomprising: a clamp that can be connected to the retractor at anyselected generally flat portion; a locking mechanism to selectively lockthe clamp to the selected generally flat portion of the retractor; afoot connected to the clamp, the foot being movable relative to theclamp while the clamp is connected to the retractor, the foot beingengageable with the patient such that extension of the foot causes theretractor to be raised and contraction of the foot causes the retractorto be lowered, whereby the retractor moves along a path; a post havingfirst and second ends and a longitudinal axis, the first end connectedto and extending from the clamp, the longitudinal axis extendinggenerally parallel with the path the retractor moves along when it israised and lowered; a formation connected to the second end of the post,the formation having an opening therethrough, the opening having an axisthat is spaced from and generally parallel with the longitudinal axis ofthe post; a rack having first and second ends and notches along oneside, the rack being disposed within the opening for movement back andforth therein, the foot being connected to the first end of the rack; arotatable pinion carried by the formation, the pinion being in contactwith the notches; a wingnut connected to the pinion, the wingnut beingaccessible to a user; and a pawl having first and second ends connectedto the formation, the first end being spring-biased toward contact withthe notches and the second end being accessible to a user, the pawlbeing pivotally mounted to the formation such that the first end permitsmovement of the rack in one direction and prevents movement of the rackin the other direction.
 4. The lifting mechanism of claim 3, wherein theopening in the formation is non-round in cross-section and the rack isof a size and shape to fit snugly within the opening.
 5. Apparatus foruse in a surgical procedure, comprising: a surgical retractor, theretractor including: first and second arms connected by a crossbar, thefirst arm being fixed to the crossbar and the second arm being movablealong the crossbar toward and away from the first arm; grips included aspart of the first and second arms that engage and separate the sides ofan incision that has been made in a patient; and generally flat portionsincluded as part of the first and second arms and the crossbar; and alifting mechanism, the lifting mechanism including: a clamp that can beconnected to the retractor at any selected generally flat portion; alocking mechanism to selectively lock the clamp to the selectedgenerally flat portion of the retractor; a foot connected to the clamp,the foot being movable relative to the clamp while the clamp isconnected to the retractor, the foot being engageable with the patientsuch that extension of the foot causes the retractor to be raised andcontraction of the foot causes the retractor to be lowered, whereby theretractor moves along a path; a post having first and second ends and alongitudinal axis, the first end connected to and extending from theclamp, the longitudinal axis extending generally parallel with the paththe retractor moves along when it is raised and lowered; a formationconnected to the second end of the post, the formation having an openingtherethrough, the opening having an axis that is spaced from andgenerally parallel with the longitudinal axis of the post; a rack havingfirst and second ends and notches along one side, the rack beingdisposed within the opening for movement back and forth therein, thefoot being connected to the first end of the rack; a rotatable pinioncarried by the formation, the pinion being in contact with the notches;a wingnut connected to the pinion, the wingnut being accessible to auser; and a pawl having first and second ends connected to theformation, the first end being spring-biased toward contact with thenotches and the second end being accessible to a user, the pawl beingpivotally mounted to the formation such that the first end permitsmovement of the rack in one direction and prevents movement of the rackin the other direction.
 6. The apparatus of claim 5, wherein the openingin the formation is non-round in cross-section and the rack is of a sizeand shape to fit snugly within the opening.
 7. The lifting mechanism ofclaim 1, wherein the clamp is generally C-shaped and includes: a pair ofspaced-apart members that are generally parallel with each other, thespaced-apart members defining a space therebetween into which a selectedgenerally flat portion of the retractor can be disposed; and aconnection between the spaced-apart members along one edge thereof. 8.The lifting mechanism of claim 1, wherein the locking mechanismcomprises: a threaded opening in the clamp; and a threaded pin thatextends through the threaded opening in the clamp, the threaded pinadapted to engage the selected generally flat portion of the retractor.9. The lifting mechanism of claim 3, wherein the clamp is generallyC-shaped and includes: a pair of spaced-apart members that are generallyparallel with each other, the spaced-apart members defining a spacetherebetween into which a selected generally flat portion of theretractor can be disposed; and a connection between the spaced-apartmembers along one edge thereof.
 10. The lifting mechanism of claim 3,wherein the locking mechanism comprises: a threaded opening in theclamp; and a threaded pin that extends through the threaded opening inthe clamp, the threaded pin adapted to engage the selected generallyflat portion of the retractor.
 11. The apparatus of claim 5, wherein theclamp is generally C-shaped and includes: a pair of spaced-apart membersthat are generally parallel with each other, the spaced-apart membersdefining a space therebetween into which a selected generally flatportion of the retractor can be disposed; and a connection between thespaced-apart members along one edge thereof.
 12. The apparatus of claim5, wherein the locking mechanism comprises: a threaded opening in theclamp; and a threaded pin that extends through the threaded opening inthe clamp, the threaded pin adapted to engage the selected generallyflat portion of the retractor.
 13. The apparatus of claim 5, wherein theclamp is connected to a generally flat portion included as part ofeither the first arm or the second arm.